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NHS hospitals: Swine flu latest from the NHS

There has been a substantial fall in new swine flu cases in the past week, with an estimated 22,000, down from 46,000 the week before. There was a marked decrease among young adults and older children. This is the fourth consecutive week that cases have fallen.

Despite this reduction, the number of people in hospital remains high, at 747. Of these, 161 are in critical condition.

Sir Liam Donaldson, the chief medical officer said, “We’re not sitting here claiming victory, because there are still many things to worry about.“

A large proportion of those in hospital are children under five, a group recently prioritised to receive swine flu vaccinations. Sir Liam suggested, however, that many of these children may actually have respiratory syncytial virus (RSV), a flu-like illness that commonly becomes a problem at this time of year.

The number of deaths from swine flu has also grown, with 15 deaths in England in the past week. The UK death total stands at 270: 178 in England, 54 in Scotland, 25 in Wales and 13 in Northern Ireland.

The vaccination programme continues successfully, with an estimated 1.6 million people in the priority groups vaccinated so far. To date, 275,000 doses have been administered to frontline health workers, twice the number that received the seasonal flu jab in the whole of the last flu season.

Young children made a priority

Children between the ages of six months and five years will soon be offered the swine flu vaccine. The move is based on evidence that they are more likely than other groups to be hospitalised. There have also been high rates of admission to critical care in this age group.

Sir Liam urged everyone who is offered the vaccine to accept it:

“While the risks of serious complications from flu may be small, the impact on those affected can be devastating.

“Protecting those most at risk from the disease will reduce the levels of serious illness and deaths. That’s why we will shortly offer the vaccine to young children”.

Parents of children who are over six months and under five years old should wait to be contacted by their local GP surgery.

Vaccinations

Vaccination of people in clinical risk groups is well under way, with an estimated 1.6 million doses of vaccine administered so far. NHS hospitals and GPs are now vaccinating patients facing the greatest risk of complications. Patients will be contacted by their GPs if they fall into one of the at-risk categories.

Healthcare staff dealing with the public are also being vaccinated to help keep medical services running smoothly and to prevent them from passing the virus to patients.

Recently, healthy children aged six months and over to under five years were added to the priority groups. Vaccination of this group will begin shortly. Parents of children of this age should wait to be contacted by their local surgery.

Who is a priority for vaccination?

People who are most at risk from swine flu need to be vaccinated first. These groups are, in order of priority:

People aged between six months and 65 years in the seasonal flu vaccine at-risk groups.

All pregnant women. The European Medicines Agency has indicated the vaccine can be given to pregnant women regardless of their stage of pregnancy.

People who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS.

People aged 65 and over in the seasonal flu vaccine at-risk groups.

Healthy children aged six months and over to under five years.

Frontline health and social care workers will also be offered the vaccine at the same time as the first clinical at-risk groups. Health and social care workers are both at an increased risk of catching swine flu and of spreading it to other at-risk patients.

immunosuppression (a suppressed immune system), due to disease or treatment.

Planning assumptions

Revised guidance for planners was issued on October 22. The new guidance is based on the latest scientific understanding of the swine flu virus, drawing on our own experience to date and the southern hemisphere’s experience of winter.

This improved understanding means it is now anticipated that the impact of the virus on the UK is likely to be less severe than previously thought.

The additional information now available confirms earlier guidance that children under 16 are significantly more susceptible to the virus, and up to 30% may fall ill during this second wave.

The worst-case clinical attack rate is revised down from 30% to 12% between October 1 and the end of the normal flu season. The worst-case hospitalisation rate is now considered to be 35,000 with up to 5,300 requiring critical care over the same period. The worst case number of deaths is now assumed to be a further 1,000 spread across all age groups.

The threat that swine flu still poses should not, however, be underestimated.

Up to 1.5 million people could still become ill in the peak week. Children under 16 are particularly susceptible to the illness and unfortunately in rare cases healthy children have developed severe complications.

Who is at greatest risk of serious complications from swine flu?

Some people are more at risk of complications if they catch swine flu, and need to start taking antivirals as soon as it is confirmed that they have the illness. Doctors may advise some high-risk patients to take antivirals before they have symptoms, if someone close to them has swine flu.

It is already known that people are particularly vulnerable if they have:

immunosuppression (whether caused by disease or treatment), or diabetes mellitus.

Also at risk are:

patients who have had drug treatment for asthma in the past three years,

pregnant women,

people aged 65 and over, and

children under five.

National Pandemic Flu Service

The National Pandemic Flu Service was launched in July. This online service assesses patients for swine flu and, if required, gives them an authorisation number that can be used to collect antiviral medication.

The system, which can also be accessed by phone, will take the strain off GPs as swine flu spreads. For the moment, it is being used only in England.

“The National Pandemic Flu Service is a new self-care service which will give people with pandemic swine flu symptoms fast access to information and antivirals,” said a Department of Health spokesman.

“This new service will free up GPs, enabling them to deal with other illnesses that need their urgent attention.”

The launch of the system brought important changes to the official advice that is given to people who think they may have swine flu. That advice – and the new system – is supported by the Royal College of General Practitioners.

Swine flu medicines

To learn about the medicines used to treat pandemic flu, including the benefits and side-effects, go to the pandemic flu medicine guide.

Reporting side effects

If you take an antiviral and have suspected side effects, first contact your GP to check that you are OK. You can then report your side effects on MHRA's new online system.

Advice for antivirals

Several newspapers reported that the World Health Organization (WHO) had changed its advice regarding use of antivirals for swine flu. Its advice suggests that while antivirals should always be given in serious cases, they may not always be necessary for otherwise healthy people.

The papers pointed out that this appeared to differ from the approach taken in the UK, where Tamiflu is being widely used.

However, the Department of Health said: "We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.

"The WHO recommendations are in fact in line with UK policy on antivirals. We have consistently said that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.”

Advice for antivirals

Several newspapers reported that the World Health Organization (WHO) had changed its advice regarding use of antivirals for swine flu. Its advice suggests that while antivirals should always be given in serious cases, they may not always be necessary for otherwise healthy people.

The papers pointed out that this appeared to differ from the approach taken in the UK, where Tamiflu is being widely used.

However, the Department of Health said: "We believe a safety-first approach of offering antivirals, when required, to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.

"The WHO recommendations are in fact in line with UK policy on antivirals. We have consistently said that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them.

Latest advice

If you have flu-like symptoms and are concerned that you may have swine flu, the advice is to stay at home and check your symptoms at the National Pandemic Flu Service.

Patients with swine flu typically have a fever or a high temperature (over 38°C / 100.4°F) and two or more of the following symptoms:

unusual tiredness,

headache,

runny nose,

sore throat,

shortness of breath or cough,

loss of appetite,

aching muscles,

diarrhoea or vomiting

Call your GP if:

you have a serious underlying (existing) illness,

you're pregnant,

you have a sick child under one year old,

your condition suddenly gets much worse, or

your condition is still getting worse after seven days (five for a child).

For people who do not have internet access, the National Pandemic Flu Service can be accessed by phone on:

How dangerous is swine flu?

The vast majority of cases reported so far in this country have been mild. Only a small number have led to serious illness, and these have frequently been where patients have had underlying health problems.

There has been an argument put forward that the government should restrict antivirals to those groups who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, then the NHS should let the virus run its course, treating it with paracetamol and bed rest, as for normal flu.

However, the government’s Scientific Advisory Group for Emergencies (SAGE) believes there is still some uncertainty about the risk profile of the virus. For instance, there are reports of some cases in Argentina where young, healthy adults have apparently become extremely ill from swine flu.

While there is still this doubt, the government has decided to continue offering Tamiflu to everyone with swine flu at their doctor's discretion.

"We will keep this matter under review, with advice from SAGE," said health minister Andy Burnham.

Catch it, Bin it, Kill it

Although the UK has moved to a treatment phase for swine flu, it’s important that people continue to do everything they can to stop the virus from spreading.

The most important way to stop it spreading is to have good respiratory hygiene (i.e. sneezing and coughing into a tissue) and hand hygiene (keeping your hands clean). The video Catch it, Bin It, Kill It explains the importance of catching your sneeze in a tissue, placing it quickly in a bin and washing your hands and surfaces regularly to kill the virus.